Cirugía valvular

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Whole Blood Adsorber During CPB and Need for Vasoactive Treatment After Valve Surgery in Acute Endocarditis: A Randomized Controlled Study

Valvular cardiac surgery - Lun, 03/28/2022 - 10:00

J Cardiothorac Vasc Anesth. 2022 Feb 26:S1053-0770(22)00137-9. doi: 10.1053/j.jvca.2022.02.028. Online ahead of print.

ABSTRACT

OBJECTIVES: Patients with endocarditis requiring urgent valvular surgery with cardiopulmonary bypass are at a high risk of developing systemic inflammatory response syndrome and septic shock, necessitating intensive use of vasopressors after surgery. The use of a cytokine hemoadsorber (CytoSorb, CytoSorbents Europe GmbH, Germany) during cardiac surgery has been suggested to reduce the risk of inflammatory activation. The study authors hypothesized that adding a cytokine adsorber would reduce cytokine burden, which would translate into improved hemodynamic stability.

DESIGN: A randomized, controlled, nonblinded clinical trial.

SETTING: At a university hospital, tertiary referral center.

PARTICIPANTS: Nineteen patients with endocarditis undergoing valve surgery.

INTERVENTION: A cytokine hemoadsorber integrated into the cardiopulmonary bypass circuit.

MEASUREMENTS AND MAIN RESULTS: The accumulated norepinephrine dose in the intervention group was half or less at all postoperative time points compared to the control group, although it did not reach statistical significance; at 24 and 48 hours (median 36 [25-75 percentiles; 12-57] μg v 114 [25-559] μg, p = 0.11 and 36 [12-99] μg v 261 [25-689] μg, p = 0.09). There was no significant difference in chest tube output, but there was a significantly lower need for the transfusion of red blood cells (285 [0-657] mL v 1,940 [883-2,148] mL, p = 0.03).

CONCLUSIONS: There was no statistically significant difference between the groups with regard to vasopressor use after surgery for endocarditis with the use of a cytokine hemoadsorber during cardiopulmonary bypass. Additional, larger randomized controlled trials are needed to definitely assess the potential effect.

PMID:35341666 | DOI:10.1053/j.jvca.2022.02.028

Categorías: Cirugía valvular

Eptifibatide bridging therapy for staged carotid artery stenting and cardiac surgery: Safety and feasibility

Valvular cardiac surgery - Lun, 03/28/2022 - 10:00

Vascular. 2022 Mar 26:17085381221084813. doi: 10.1177/17085381221084813. Online ahead of print.

ABSTRACT

BACKGROUND: Prophylactic carotid artery stenting (CAS) is an effective strategy to reduce perioperative stroke in patients with severe carotid stenosis who require cardiothoracic surgery (CTS). Staging both procedures (CAS-CTS) during a single hospitalization presents conflicting demands for antiplatelet therapy and the optimal pharmacologic strategy between procedures is not established. The purpose of this study is to present our initial experience with a "bridging" protocol for staged CAS-CTS.

METHODS: A retrospective review of staged CAS-CTS procedures at a single referral center was performed. All patients had multivessel coronary and/or valvular disease and severe carotid stenosis (>70%). Patients not previously on aspirin were also started on aspirin prior to surgery, followed by eptifibatide during CAS (intraprocedural bolus followed by post-procedural infusion which was continued until the morning of surgery). Pre- and perioperative (30 days) neurologic morbidity and mortality was the primary endpoint.

RESULTS: 11 CAS procedures were performed in 10 patients using the protocol. The median duration of eptifibatide bridge therapy was 36 h (range 24-288 h). There was one minor bleeding complication (1/11, 9.1%) and no major bleeding complications during the bridging and post-operative period. There was one post-operative, non-neurologic death and zero perioperative ischemic strokes.

CONCLUSIONS: For patients undergoing staged CAS-CTS, Eptifibatide bridging therapy is a viable temporary antiplatelet strategy with a favorable safety profile. This strategy enables a flexible range of time-intervals between procedures.

PMID:35341420 | DOI:10.1177/17085381221084813

Categorías: Cirugía valvular

Severe Valvular Heart Disease and COVID-19: Results from the Multicenter International Valve Disease Registry

Valvular cardiac surgery - Lun, 03/28/2022 - 10:00

Struct Heart. 2021 Apr;5(4):424-426. doi: 10.1080/24748706.2021.1908646. Epub 2022 Mar 21.

NO ABSTRACT

PMID:35340822 | PMC:PMC8935903 | DOI:10.1080/24748706.2021.1908646

Categorías: Cirugía valvular

The First Case of <em>Granulicatella adiacens</em> Identified from a Resected Heart Valve by Next Generation Sequencing (NGS) in Poland

Valvular cardiac surgery - Sáb, 03/26/2022 - 10:00

Pathogens. 2022 Feb 25;11(3):295. doi: 10.3390/pathogens11030295.

ABSTRACT

In this report, we describe the course and successful treatment of a case of complicated infective endocarditis (IE). A patient presented with a high-grade, irregular fever with chills lasting at least 2 months along with dyspnoea, chest pain, fatigue, weight loss, and night sweats during the previous 3 months. As well as cardiac congenital disorders, he was found to have Granulicatella adiacens infective aortic valve endocarditis, presumably transmitted from the oral cavity niche. Validated metagenomic 16S rDNA next generation sequencing was used to perform taxonomic identification, allowing for specific adequate antibiotic therapy instead of empiric therapy. This paper highlights the critical role of rapid taxonomic identification of nutritionally variant streptococci and the benefit of proper IE treatment in avoiding relapses or fatal complications.

PMID:35335619 | PMC:PMC8950401 | DOI:10.3390/pathogens11030295

Categorías: Cirugía valvular

Eisenmenger Syndrome: JACC State-of-the-Art Review

Valvular cardiac surgery - Vie, 03/25/2022 - 10:00

J Am Coll Cardiol. 2022 Mar 29;79(12):1183-1198. doi: 10.1016/j.jacc.2022.01.022.

ABSTRACT

Although major breakthroughs in the field of pediatric cardiology, cardiac surgery, intervention, and overall care improved the outlook of congenital heart disease, Eisenmenger syndrome (ES) is still encountered and remains a complex clinical entity with multisystem involvement, including secondary erythrocytosis, increased thrombotic and bleeding diathesis, high arrhythmogenic risk, progressive heart failure, and premature death. Clearly, care for ES is best delivered in multidisciplinary expert centers. In this review, we discuss the considerable recent progress in understanding the complex pathophysiology of ES, means of prognostication, and improvement in clinical outcomes achieved with pulmonary arterial hypertension-targeted therapies. Additionally, we delineate areas of uncertainty in various aspects of care, discuss gaps in current evidence, and review current status in less privileged countries and propose initiatives to reduce disease burden. Finally, we propose the application of emerging technologies to enhance the delivery and quality of health care related to ES and beyond.

PMID:35331414 | DOI:10.1016/j.jacc.2022.01.022

Categorías: Cirugía valvular

miRNAs in Cardiac Myxoma: New Pathologic Findings for Potential Therapeutic Opportunities

Valvular cardiac surgery - Vie, 03/25/2022 - 10:00

Int J Mol Sci. 2022 Mar 18;23(6):3309. doi: 10.3390/ijms23063309.

ABSTRACT

MicroRNAs (miRNAs) regulate gene expression at the post-transcriptional level, contributing to all major cellular processes. The importance of miRNAs in cardiac development, heart function, and valvular heart disease has been shown in recent years, and aberrant expression of miRNA has been reported in various malignancies, such as gastric cancer and breast cancer. Different from other fields of investigation, the role of miRNAs in cardiac tumors still remains difficult to interpret due to the scarcity publications and a lack of narrative focus on this topic. In this article, we summarize the available evidence on miRNAs and cardiac myxomas and propose new pathways for future research. miRNAs play a part in modifying the expression of cardiac transcription factors (miR-335-5p), increasing cell cycle trigger factors (miR-126-3p), interfering with ceramide synthesis (miR-320a), inducing apoptosis (miR-634 and miR-122), suppressing production of interleukins (miR-217), and reducing cell proliferation (miR-218). As such, they have complex and interconnected roles. At present, the study of the complete mechanistic control of miRNA remains a crucial issue, as proper understanding of signaling pathways is essential for the forecasting of therapeutic implications. Other types of cardiac tumors still lack adequate investigation with regard to miRNA. Further research should aim at investigating the causal relationship between different miRNAs and cell overgrowth, considering both myxoma and other histological types of cardiac tumors. We hope that this review will help in understanding this fascinating molecular approach.

PMID:35328730 | PMC:PMC8954653 | DOI:10.3390/ijms23063309

Categorías: Cirugía valvular

Burden of hospitalizations in newly diagnosed heart failure patients in Poland: real world population based study in years 2013-2019

Valvular cardiac surgery - Jue, 03/24/2022 - 10:00

ESC Heart Fail. 2022 Mar 24. doi: 10.1002/ehf2.13900. Online ahead of print.

ABSTRACT

AIMS: We aim to report trends in unplanned hospitalizations among newly diagnosed heart failure patients with regard to hospitalizations types and their impact on outcomes.

METHODS AND RESULTS: A nation-wide study of all citizens in Poland with newly diagnosed heart failure based on ICD-10 coding who were beneficiaries of either public primary, secondary, or hospital care between 2013 and 2018 in Poland. Between 1 January 2013 and 31 December 2019, there were 1 124 118 newly diagnosed heart failure patients in Poland in both out- and inpatient settings. The median observation time was 946 days. As many as 49% experienced at least one acute heart failure hospitalization. Once hospitalized, 44.6% patients experienced at least one all-cause rehospitalization and 26% another heart failure rehospitalization. The latter had the highest Charlson co-morbidity index (1.36). The 30 day heart failure readmission rate was 2.96%. Kaplan-Meier analysis revealed very early readmissions (up to 1-7 days) were associated with better survival compared with rehospitalization between 8 and 30 days. All-cause mortality was related to the number of hospitalization with adjusted estimated hazard ratios: 1.550 (95% CI: 1.52-158) for the second HF hospitalization, 2.158 (95% CI: 2.098-2.219) for third, and 2.788 (95% CI: 2.67-2.91) for the fourth HF hospitalization and subsequent ones, as compared with the first hospitalization.

CONCLUSIONS: Among newly diagnosed heart failure patients in Poland between 2013 and 2019, nearly half required at least one unplanned heart failure hospitalization. The risk of death was growing with every other hospital reoccurrence due to heart failure.

PMID:35322601 | DOI:10.1002/ehf2.13900

Categorías: Cirugía valvular

Developing a Risk Prediction Model for Early Atrial Fibrillation Recurrence After MAZE Procedure

Valvular cardiac surgery - Lun, 03/21/2022 - 10:00

Crit Pathw Cardiol. 2022 Mar 21. doi: 10.1097/HPC.0000000000000286. Online ahead of print.

ABSTRACT

BACKGROUND: The efficiency of MAZE as a safe procedure in AF patients who underwent concomitant mitral valve surgery was more than 60%. The aim of this study was to define predictors of early AF recurrence after concomitant MAZE procedure with valvular surgery.

METHODS: In this retrospective study, 234 patients with AF underwent concomitant valvular replacement and MAZE procedure. Patients were classified into two groups of Sinus and Atrial fibrillation. Baseline characteristics of patients were then compared between two groups.

RESULT: Totally, 234 patients were enrolled, 148 of which maintained sinus rhythm during hospitalization. Left atrial diameter and type of valvular surgery were similar in both groups. Age, number of replaced valves, concomitant coronary artery bypass grafting (CABG), and history of preoperative persistent AF and beta-blocker therapy, were independent predictors of in-hospital AF recurrence. We used these variables to build a model to anticipate early AF recurrence.

CONCLUSION: Being older, multivalvular surgery, and persistent preoperative AF were the predictors of higher risk of early recurrent AF, whereas concomitant CABG and using beta-blocker had a protective effect. This model based on preoperative and operative characteristics can help us to better evaluate if the patient benefits from MAZE procedure coincide with valvular surgery.

PMID:35311757 | DOI:10.1097/HPC.0000000000000286

Categorías: Cirugía valvular

Advanced Pregnancies With Valvular Heart Disease Requiring Peripartum Cardiac Intervention: Two Case Reports and Literature Review

Valvular cardiac surgery - Lun, 03/21/2022 - 10:00

Cureus. 2022 Feb 9;14(2):e22072. doi: 10.7759/cureus.22072. eCollection 2022 Feb.

ABSTRACT

Cardiac interventions during advanced gestation carry a risk of maternal complications including mortality, along with the serious threat to the life of a viable fetus. However, with advancements in anesthesia and surgery techniques, cardiac interventions can be performed successfully during the peripartum period. We report two cases of decompensated severe valvular stenosis in the third trimester. One patient underwent balloon valvuloplasty followed by cesarean delivery. However, the other underwent a cesarean delivery followed by double valve replacement. Favorable maternal and fetal outcomes were achieved through peripartum interventions. Good fetomaternal outcomes can be obtained in women with severe valvular heart disease (VHD) presenting late in pregnancy. The decision for the timing of cardiac intervention in relation to cesarean section (CS) can vary from case-to-case basis.

PMID:35308752 | PMC:PMC8920825 | DOI:10.7759/cureus.22072

Categorías: Cirugía valvular

Impact of Right Ventricular Pressure Load After Repair of Tetralogy of Fallot

Valvular cardiac surgery - Vie, 03/18/2022 - 10:00

J Am Heart Assoc. 2022 Mar 18:e022694. doi: 10.1161/JAHA.121.022694. Online ahead of print.

ABSTRACT

Background Right ventricular outflow tract (RVOT) stenosis after repair of tetralogy of Fallot has been linked with favorable right ventricular remodeling but adverse outcomes. The aim of our study was to assess the hemodynamic impact and prognostic relevance of right ventricular pressure load in this population. Methods and Results A total of 296 patients with repaired tetralogy of Fallot (mean age, 17.8±7.9 years) were included in a prospective cardiovascular magnetic resonance multicenter study. Myocardial strain was quantified by feature tracking technique at study entry. Follow-up, including the need for pulmonary valve replacement, was assessed. The combined end point consisted of ventricular tachycardia and cardiac death. A higher echocardiographic RVOT peak gradient was significantly associated with smaller right ventricular volumes and less pulmonary regurgitation, but lower biventricular longitudinal strain. During a follow-up of 10.1 (0.1-12.9) years, the primary end point was reached in 19 of 296 patients (cardiac death, n=6; sustained ventricular tachycardia, n=2; and nonsustained ventricular tachycardia, n=11). A higher RVOT gradient was associated with the combined outcome (hazard ratio [HR], 1.03; 95% CI, 1.00-1.06; P=0.026), and a cutoff gradient of ≥25 mm Hg was predictive for cardiovascular events (HR, 3.69; 95% CI, 1.47-9.27; P=0.005). In patients with pulmonary regurgitation ≥25%, a mild residual RVOT gradient (15-30 mm Hg) was not associated with a lower risk for pulmonary valve replacement. Conclusions Higher RVOT gradients were associated with less pulmonary regurgitation and smaller right ventricular dimensions but were related to reduced biventricular strain and emerged as univariate predictors of adverse events. Mild residual pressure gradients did not protect from pulmonary valve replacement. These results may have implications for the indication for RVOT reintervention in this population.

PMID:35301850 | DOI:10.1161/JAHA.121.022694

Categorías: Cirugía valvular

Arterial Stiffness in Aortic Stenosis and the Impact of Aortic Valve Replacement

Valvular cardiac surgery - Vie, 03/18/2022 - 10:00

Vasc Health Risk Manag. 2022 Mar 8;18:117-122. doi: 10.2147/VHRM.S358741. eCollection 2022.

ABSTRACT

The most common cause for interventional valve treatment is aortic stenosis. A cardinal symptom of aortic stenosis is heart failure due to the increased load exerted on the left ventricle. However, the left ventricular load is not solely determined based on the degree of aortic stenosis but is also impacted by arterial stiffness. The combined load can be determined by valvulo-arterial impedance (Zva), which is associated with poor outcome in aortic stenosis. We recently demonstrated low measures of systemic arterial stiffness in patients with aortic stenosis, and that arterial stiffness was increased after surgical aortic valve replacement. The results indicated a masked arterial stiffness in aortic stenosis when using methods incorporating peripheral arterial segments. Available studies using several different methods to assess arterial stiffness in relatively small aortic stenosis cohorts examined before and after either surgical or transcatheter aortic valve replacement/intervention have generated contradictory results. In this commentary, we present a detailed literature review to explore how different methods and measures of arterial stiffness in aortic stenosis capture or not, a masked arterial stiffness in aortic stenosis and possible reasons for the observed results. Future studies validating a non-invasive reproducible method to assess arterial stiffness in aortic stenosis patients could potentially lead to an implementation in pre-interventional risk assessment for aortic stenosis.

PMID:35300364 | PMC:PMC8922807 | DOI:10.2147/VHRM.S358741

Categorías: Cirugía valvular

Abnormal wire's trajectory during edge-to-edge mitral valve repair-a rare case report of inferior vena cava anomaly

Valvular cardiac surgery - Jue, 03/17/2022 - 10:00

Eur Heart J Case Rep. 2022 Feb 7;6(2):ytac060. doi: 10.1093/ehjcr/ytac060. eCollection 2022 Feb.

ABSTRACT

BACKGROUND: Inferior vena cava (IVC) anomalies are rare and diagnosed incidentally as most patients are asymptomatic. We present a case where an abnormal course of the wire during percutaneous mitral valve repair revealed abnormal IVC anatomy leading to procedure termination. We summarized all IVC anomalies relevant to cardiovascular physicians and designed a simplified tool to illustrate their course for differential diagnosis.

CASE SUMMARY: A 78-year-old female presented with severe and symptomatic mitral regurgitation. The heart team decided to proceed with a percutaneous option, considering the patient's high surgical risk. While ascending from the femoral vein, the wire took an abnormal course to the left side of the vertebrae and continued beyond the cardiac silhouette downwards the right atrium (RA). We decided to abort the procedure due to the high risk for vascular complications assuming the need to cross it with the device's delivery system. Retrospective computed tomography analysis revealed an interrupted IVC at the level of the renal vasculature and azygos continuation toward the RA via a dilated superior vena cava. The patient was referred to surgery and had successful mitral and tricuspid valve repair and was discharged home in good health.

DISCUSSION: The increased number of minimally invasive percutaneous procedures, especially for valvular heart disease, mandates a profound understanding of the arterial, and venous system anatomy. Inferior vena cava anomalies represent a group of anomalies with different paths and variations and have a tremendous impact on all aspects of the procedure.

PMID:35295723 | PMC:PMC8922697 | DOI:10.1093/ehjcr/ytac060

Categorías: Cirugía valvular

Differential Biological Effects of Dietary Lipids and Irradiation on the Aorta, Aortic Valve, and the Mitral Valve

Valvular cardiac surgery - Jue, 03/17/2022 - 10:00

Front Cardiovasc Med. 2022 Feb 28;9:839720. doi: 10.3389/fcvm.2022.839720. eCollection 2022.

ABSTRACT

AIMS: Dietary cholesterol and palmitic acid are risk factors for cardiovascular diseases (CVDs) affecting the arteries and the heart valves. The ionizing radiation that is frequently used as an anticancer treatment promotes CVD. The specific pathophysiology of these distinct disease manifestations is poorly understood. We, therefore, studied the biological effects of these dietary lipids and their cardiac irradiation on the arteries and the heart valves in the rabbit models of CVD.

METHODS AND RESULTS: Cholesterol-enriched diet led to the thickening of the aortic wall and the aortic valve leaflets, immune cell infiltration in the aorta, mitral and aortic valves, as well as aortic valve calcification. Numerous cells expressing α-smooth muscle actin were detected in both the mitral and aortic valves. Lard-enriched diet induced massive aorta and aortic valve calcification, with no detectable immune cell infiltration. The addition of cardiac irradiation to the cholesterol diet yielded more calcification and more immune cell infiltrates in the atheroma and the aortic valve than cholesterol alone. RNA sequencing (RNAseq) analyses of aorta and heart valves revealed that a cholesterol-enriched diet mainly triggered inflammation-related biological processes in the aorta, aortic and mitral valves, which was further enhanced by cardiac irradiation. Lard-enriched diet rather affected calcification- and muscle-related processes in the aorta and aortic valve, respectively. Neutrophil count and systemic levels of platelet factor 4 and ent-8-iso-15(S)-PGF2α were identified as early biomarkers of cholesterol-induced tissue alterations, while cardiac irradiation resulted in elevated levels of circulating nucleosomes.

CONCLUSION: Dietary cholesterol, palmitic acid, and cardiac irradiation combined with a cholesterol-rich diet led to the development of distinct vascular and valvular lesions and changes in the circulating biomarkers. Hence, our study highlights unprecedented specificities related to common risk factors that underlie CVD.

PMID:35295264 | PMC:PMC8918952 | DOI:10.3389/fcvm.2022.839720

Categorías: Cirugía valvular

Multi-modality imaging assessment of native valvular regurgitation: an EACVI and ESC council of valvular heart disease position paper

Valvular cardiac surgery - Mié, 03/16/2022 - 10:00

Eur Heart J Cardiovasc Imaging. 2022 Mar 16:jeab253. doi: 10.1093/ehjci/jeab253. Online ahead of print.

ABSTRACT

Valvular regurgitation represents an important cause of cardiovascular morbidity and mortality. Imaging is pivotal in the evaluation of native valve regurgitation and echocardiography is the primary imaging modality for this purpose. The imaging assessment of valvular regurgitation should integrate quantification of the regurgitation, assessment of the valve anatomy and function, and the consequences of valvular disease on cardiac chambers. In clinical practice, the management of patients with valvular regurgitation largely relies on the results of imaging. It is crucial to provide standards that aim at establishing a baseline list of measurements to be performed when assessing native valve regurgitation. The present document aims to present clinical guidance for the multi-modality imaging assessment of native valvular regurgitation.

PMID:35292799 | DOI:10.1093/ehjci/jeab253

Categorías: Cirugía valvular

Sex-Related Differences in Postoperative Outcomes After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-analysis

Valvular cardiac surgery - Mar, 03/15/2022 - 10:00

Cardiol Rev. 2022 Mar 15. doi: 10.1097/CRD.0000000000000448. Online ahead of print.

ABSTRACT

Aortic stenosis (AS) is the most common valvular disease of the heart and is increasing in prevalence. Previous literature has found inferior outcomes for females undergoing surgical aortic valve replacement (SAVR), while recent investigations have found equivalent or superior outcomes for females undergoing transcatheter aortic valve replacement (TAVR). PubMed and Medline were systematically searched for articles published from January 1st 2010 to April 30th 2021 for retrospective and prospective studies comparing outcomes between males and females undergoing TAVR. 1,180 titles and abstracts were screened and 28 were included in this review. Risk of bias was assessed using questions derived from the ROBINS-I tool and previous literature. The data were compiled and analyzed using the RevMan 5.4 software. The results of this review confirm the previously published literature and have found rates of acute kidney injury (p=0.05) and postoperative pacemaker insertion (p<0.00001) favoring females, and in-hospital mortality (p=0.04), stroke (p<0.00001), bleeding complications (p<0.00001), and vascular complications (p<0.00001) favoring males. The previously published literature has demonstrated consistently inferior outcomes for females undergoing heart valve surgery when compared to males. However, contemporary literature investigating sex differences after TAVR has found comparable outcomes for females. While the postoperative outcomes after SAVR and TAVR are well established, the causal factors are still unidentified. Future studies utilizing matching based on preoperative characteristics and follow-up including collection of postoperative ventricular remodeling and prosthetic valve performance data will aid in elucidating the causal factors impacting outcomes for males and females after TAVR.

PMID:35290250 | DOI:10.1097/CRD.0000000000000448

Categorías: Cirugía valvular

Assessing left atrial function in patients with atrial fibrillation and valvular heart disease using cardiovascular magnetic resonance imaging

Valvular cardiac surgery - Mar, 03/15/2022 - 10:00

Clin Cardiol. 2022 Mar 15. doi: 10.1002/clc.23811. Online ahead of print.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) is common arrhythmia in valvular heart disease (VHD) and is associated with adverse outcomes.

HYPOTHESIS: To evaluate the left atrial (LA) function in patients with AF-VHD by cardiovascular magnetic resonance imaging feature tracking (CMR-FT) using LA strain (εs /εe /εa ) and their corresponding strain rate (SRs/SRe/SRa).

METHODS: This was a retrospective cross-sectional inter-reader and intra-reader reproducibility conducted from July 1, 2020, to January 31, 2021. A total of 39 patients with AF-VHD (rheumatic heart valvular disease [RHVD] [n = 22], degenerative heart valvular disease [DHVD] [n = 17]) underwent MRI scans performed with drug-controlled heart rate before correcting the rhythm and valves through maze procedure. Fifteen participants with normal cardiac MRI were included as healthy control. εs /SRs, εe /SRe, and εa /SRa, corresponding to LA reservoir, conduit, and booster-pump function, were assessed using Feature Tracking software (CVI42 v5.12.1).

RESULTS: Compared with healthy controls, LA global strain parameters (εs /εe /εa /SRs/SRe/SRa) were significantly decreased (all p < 0.001), while LA size and volume were increased in AF-VHD group (all p < 0.001). In the subgroup, RHVD group showed lower LA total ejection fraction (LATEF) and strain data than DHVD group (12.6% ± 3.3% vs. 19.4 ± 8.6, p = 0.001). Decreased LATEF was significantly related to altered LA strain and strain rate, especially in εs , εe , and SRs (Pearson/Spearman r/ρ = 0.856/0.837/0.562, respectively; all p < 0.001). Interstudy and intrastudy reproducibility were consistent for LA volumetry and strain parameters (intraclass correlation coefficient: 0.88-0.99).

CONCLUSIONS: CMR-FT can be used to assess the LA strain parameters, and identify LA dysfunction and deformation noninvasively, which could be a helpful functional imaging biomarker in the clinical treatment of AF-VHD.

PMID:35289415 | DOI:10.1002/clc.23811

Categorías: Cirugía valvular

CT Planning prior to Transcatheter Mitral Valve Replacement (TMVR)

Valvular cardiac surgery - Jue, 03/10/2022 - 11:00

Rofo. 2022 Mar 10. doi: 10.1055/a-1718-4182. Online ahead of print.

ABSTRACT

BACKGROUND: Transcatheter mitral valve replacement (TMVR) is a treatment option for patients with therapy refractory high-grade mitral valve regurgitation and a high perioperative risk.During TMVR, the mitral annulus cannot be visualized directly. Therefore, comprehensive pre-interventional planning and a precise visualization of the patient's specific mitral valve anatomy, outflow tract anatomy and projected anchoring of the device are necessary.Aim of this review-article is, to assess the role of pre-procedural computed tomography (CT) for TMVR-planning METHODS: Screening and evaluation of relevant guidelines (European Society of Cardiology [ESC], American Heart Association [AHA/ACC]), meta-analyses and original research using the search terms "TVMR" or "TMVI" and "CT". In addition to this, the authors included insight from their own clinical experience.

RESULTS: CT allows for accurate measurement of the mitral annulus with high special and adequate temporal resolution in all cardiac phases. Therefore, CT represents a valuable method for accurate prosthesis-sizing.In addition to that, CT can provide information about the valvular- and outflow-tract-anatomy, mitral valve calcifications, configuration of the papillary muscles and of the left ventricle. Additionally, the interventional access-route may concomitantly be visualized.

CONCLUSION: CT plays, in addition to echocardiographic imaging, a central role in pre-interventional assessment prior to TMVR. Especially the precise depiction of the left ventricular outflow tract (LVOT) provides relevant additional information, which is very difficult or not possible to be acquired in their entirety with other imaging modalities.

KEY POINTS: · CT plays a central role in pre-interventional imaging for TMVR.. · CT-measurements allow for accurate prosthesis-sizing.. · CT provides valuable information about LVOT-anatomy, mitral calcifications and interventional access-route..

CITATION FORMAT: · Heiser L, Gohmann RF, Noack T et al. CT Planning prior to Transcatheter Mitral Valve Replacement (TMVR). Fortschr Röntgenstr 2022; DOI: 10.1055/a-1718-4182.

PMID:35272358 | DOI:10.1055/a-1718-4182

Categorías: Cirugía valvular

Sex differences in aortopathy and valve diseases among patients undergoing cardiac surgery

Valvular cardiac surgery - Jue, 03/10/2022 - 11:00

Ann Thorac Surg. 2022 Mar 7:S0003-4975(22)00304-6. doi: 10.1016/j.athoracsur.2022.02.040. Online ahead of print.

ABSTRACT

BACKGROUND: We aimed to study sex differences in aortopathy and valve disease among patients undergoing aortic valve replacement and/or surgery for ascending aortic aneurysm, and assess whether differences are specific for patients with bicuspid (BAV) compared to patients with tricuspid aortic valve (TAV).

METHODS: We used a single-center and observational cohort including 1,045 patients undergoing elective open-heart surgery for aortic valve disease and/or ascending aortic aneurysm at the Karolinska Hospital (Sweden).

RESULTS: Women (33.0%) were older than men (mean [SD]; 67.9 [11] years vs 62.5 [13] years for men; P < 0.001). No significant sex difference in prevalence of ascending aortic aneurysm was found according to absolute measures (P = 0.19), however, women had a greater dilation of the ascending aorta when normalized for body surface area (mean [SD], 21.8 [6.3] mm/m2 vs 19.3 [4.4] mm/m2 for men; P < 0.001). Among the 560 patients with BAV, women had significantly more AS (adjusted OR, 2.23; 95% CI, 1.19-4.20; P = 0.013) and less AI (adjusted OR 0.42; 95% CI, 0.23-0.78; P < 0.01); whereas no sex difference was found among patients with TAV.

CONCLUSIONS: In this large study of patients undergoing cardiac surgery, we found greater degree of aortic dilation in women compared to men suggesting a need for earlier monitoring of women. Moreover, women with BAV had a significantly higher prevalence of AS compared to men. These results describe the aorta and valvular characteristics of patients by sex and provide guidance regarding which patients might benefit from closer surveillance.

PMID:35271843 | DOI:10.1016/j.athoracsur.2022.02.040

Categorías: Cirugía valvular

Haemophilus Parainfluenzae mural endocarditis with large atrial septal defect and peripheral embolization

Valvular cardiac surgery - Mié, 03/09/2022 - 11:00

J Cardiol Cases. 2021 Sep 9;25(3):149-152. doi: 10.1016/j.jccase.2021.08.002. eCollection 2022 Mar.

ABSTRACT

Mural endocarditis is a rare subclass of infective endocarditis (IE) associated with intra-cardiac tumors, prosthesis, valvular vegetation's, or structural abnormalities such as ventricular septal defects. Bacteria classified as HACEK (Haemophilus species, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae) are rare causes of IE found in only 1.3% to 10% of cases. We describe the second reported case of mural endocarditis involving the left ventricle (LV) caused by a Haemophilus species. A young male with no prior intravenous drug use, valvular heart disease, or recent dental work presented with splenic infarcts. H. para-influenza was identified on blood cultures. Cardiac imaging revealed a 1.5 cm LV mass underneath the posterior leaflet of the mitral valve and a large Atrial Septal Defect (ASD). Awaiting surgery, the patient sustained embolic and hemorrhagic cerebral events. The patient underwent debulking of LV mass, ASD closure, and mitral valve repair complicated by post-pericardiotomy syndrome, and he completed six weeks of ceftriaxone therapy. The patient met modified Duke Criteria, but the diagnosis was challenging due to absence of risk factors, sub-acute symptom onset, delayed blood culture growth, and ambiguous characterization of the mass on imaging. <Learning objective: To recognize mural endocarditis as a distinct subset of infective endocarditis and understand its risk factors. To appreciate the unique diagnostic and prognostic considerations of HACEK endocarditis. To understand the indications for urgent surgical intervention in treatment of infective endocarditis>.

PMID:35261698 | PMC:PMC8888727 | DOI:10.1016/j.jccase.2021.08.002

Categorías: Cirugía valvular
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